January 2014

Out on a limb: Many risky returns

“Something bad is going to happen to Percy Harvin today,” I said to my husband during the first quarter of the January 11 playoff game between Seattle Seahawks and the New Orleans Saints.

A lot of people were watching Harvin that day, as the Seahawks receiver returned to National Football League (NFL) competition for the first time since mid-November and five months after undergoing surgery to repair a torn labrum in his hip.

Early in the game, Harvin seemed to be running well. But the second time he attempted to catch a pass, he took a hard hit from Saints safety Rafael Bush, smacked his helmet on the artificial turf, and was slow to get up–a sure sign that a concussion assessment was in order. Yet, just 10 minutes later, he was back in the game. That’s when I suspected things wouldn’t end well.

And sure enough, just before halftime, Harvin leaped in the end zone for an overthrown pass and–though untouched–landed hard, again hitting his head on the turf. This time, he went to the locker room and didn’t return, and it shouldn’t have surprised anyone when the team announced he had suffered a concussion.

Afterward, some sports medicine experts suggested that Harvin shouldn’t have been allowed back in the game after the first incident. But I wonder if he should have been playing at all.

Regular readers of LER know that a growing body of evidence suggests a connection between concussion and musculoskeletal injury (see “Brains and sprains: Is there an extremity-concussion link?” October 2012, page 11). This means returning to play too soon from a concussion may increase an athlete’s risk of lower extremity injury. But it also means returning to play too soon from a lower extremity injury may increase an athlete’s risk of concussion.

Harvin was first cleared to play in Week 11 against the Minnesota Vikings, but was on the field for only 16 snaps, primarily as a decoy. His hip pain flared up in the ensuing days, and he didn’t participate fully in practice again until early January.

In the week leading up to the Saints game, teammates and coaches raved to the media about how good Harvin looked in practice. But that doesn’t mean his body was game ready–much less playoff-game ready.

Many experts believe that new NFL rules limiting off-season training contributed to higher rates of anterior cruciate ligament injury early in the season (see “The NFL’s ACL issue,” September 2013, page 11). By the same logic, a player coming back from a serious injury after just one week of full practice could be at risk for another musculoskeletal injury–or, potentially, a concussion.

In New England, where I live, we saw a similar sequence of events with Patriots receiver Danny Amendola. Amendola suffered a groin injury in Week 1, played sparingly in Week 5, and suffered a concussion in Week 6. I don’t think that’s a coincidence.

No player wants to spend weeks in rehab just to end up back on the sideline with a concussion. Smarter return-to-play criteria are key to keeping those comebacks on track.

One Response to Out on a limb: Many risky returns

Thank you for a very lucid explanation and insight into the medical problems associated with America’s athletic pastime, or in some cases, obsession. It is difficult to change a culture
because the owners ($) expect a return on their investment (players) and the players are under contract to perform. Now it is weird enough that the NFL is a non-profit organization, but they are paid by the same set of people who want high revenue and pay players millions to play football, not to be sidelined with injury. It is the proverbial viscous circle.